This chapter is from the book

This chapter is from the book

Chapter 3: Caring for the Client with Disorders of the Respiratory System

Terms you'll need to understand:

Acute respiratory failure

Apnea

Asthma

Atelectasis

Bronchitis

Continuous positive airway pressure (CPAP)

Cor pulmonale

Cyanosis

Dyspnea

Emphysema

Empyema

Hemoptysis

Hypoxemia

Hypoxia

Pleural effusion

Pleurisy

Pneumonia

Pulmonary embolus

Tachypnea

Nursing skills you'll need to master:

Assessing breath sounds

Providing tracheostomy care

Collecting sputum

Teaching proper use of an inhaler

Performing postural drainage

Assisting with thoracentesis

Obtaining a throat culture

Performing venopuncture

Administering medication

Managing chest tubes

Maintaining oxygen therapy

Acute Respiratory Failure

Acute respiratory failure can be defined as the lungs’ failure
to meet the body’s oxygen requirements. Two acute respiratory conditions
you need to be familiar with are ARDS and RDS.

Acute Respiratory Distress Syndrome

Acute respiratory distress syndrome, commonly known as ARDS or
non-cardiogenic pulmonary edema, occurs mostly in otherwise healthy
persons. ARDS can be the result of anaphylaxis, aspiration, pulmonary emboli,
inhalation burn injury, or complications from abdominal or thoracic surgery.
ARDS may be diagnosed by a chest x-ray that will reveal emphysematous changes
and infiltrates that give the lungs a characteristic appearance described as
ground glass. Assessment of the client with ARDS reveals

Hypoxia

Sternal and costal retractions

Presence of rales or rhonchi

Diminished breath sounds

Refractory hypoxemia

Care of the client with ARDS involves

Use of assisted ventilation

Monitoring of arterial blood gases

Attention to nutritional needs

Prone positioning or use of specialized beds to minimize consolidation of
infiltrates in large airways

Investigational therapies, include the use of vitamins C and E, aspirin,
interleukin, and surfactant replacements.

Respiratory Distress Syndrome

Respiratory distress syndrome (RDS), once referred to as hyaline
membrane disease, occurs most often in preterm infants and is the result of
insufficient surfactant production. Administering dexamethasone (Decadron) 24
hours prior to delivery has been shown to be effective in speeding fetal
maturity and may be used in cases where early delivery is unavoidable. Infants
with RDS are placed on ventilator support and treated with surfactant
replacement.

Pulmonary Embolus

Pulmonary embolus refers to the obstruction of the pulmonary artery
or one of its branches by a clot or some other undissolved matter, such as fat
or a gaseous substance. Clots can originate anywhere in the body but are most
likely to migrate from a vein deep in the legs, pelvis, kidney, or arms. Fat
emboli are associated with fractures of the long bones, particularly the
femur. Air emboli, which are less common, can occur during the
insertion or use of central lines. Common risk factors for the development of
pulmonary embolus include immobilization, fractures, trauma, and history of clot
formation.

TIP

Remember the three Fs of fat emboli:

Fat

Femur

Football player

Most fat emboli come from fractured femurs; most fractured femurs occur in
young men 18–25, the age of most football players.

Symptoms of a pulmonary embolus depend on the size and location of the clot
or undissolved matter. Symptoms include

Chest pain

Dyspnea

Syncope

Hemoptysis

Tachycardia

Hypotension

Sense of apprehension

Petechiae over the chest and axilla

Distended neck veins

Diagnostic tests to confirm the presence of pulmonary embolus include chest
x-ray, pulmonary angiography, lung scan, and ECG to rule out myocardial
infarction. Management of the client with a pulmonary embolus includes

Placing the client in high Fowler’s position

Administering oxygen via mask

Giving medication for chest pain

Using thrombolytics/anticoagulants

Antibiotics are indicated for those with septic emboli. Surgical management
using umbrella-type filters is indicated for those who cannot take
anticoagulants as well as for the client who has recurrent emboli while taking
anticoagulants. Clients receiving anticoagulant therapy should be observed for
signs of bleeding. PT, INR, and PTT are three tests used to track the
client’s clotting time. You can refer to Chapter 13, "Caring for the
Client with Disorders of the Cardiovascular System," for a more complete
discussion of these tests.

CAUTION

Streptokinase is made from beta strep; therefore, clients with a history of
strep infections may respond poorly to anticoagulant therapy with streptokinase
because they might have formed antibodies.

CAUTION

Streptokinase is not clot specific; therefore, the client may develop a
tendency to bleed from incision or injection sites.